CAM Proponents long on passion, short on facts.

I often peruse the alternative medicine news sites looking at what they are saying and how news is being presented in that community. As a rule, not terribly great science reporting. When I see a title like “Mainstream” Doctors and Nurses Often Use Alternative Medicine for Themselves“, it always catches my attention. A good skeptic will read this title and be suspicious. Sometimes I find the content surprising but not in this case. I am genuinely impressed by how efficient Complementary and Alternative Medicine proponents have become at weaving propaganda without telling a bald faced lie.

To the average person this title is compelling. This article proposes doctors everywhere are using alternative medicine. The author suggests that “medical professionals” keep the alternative treatment to themselves while recommending drugs for you. The evidence given is sorely lacking in quality and quantity. In my opinion, the article is a cleverly written pro-CAM piece that avoids the evidence. I should say the lack of evidence.

I think that it is fair to do a critical evaluation of statements, about members of my profession, and what is implied.

The title is purposefully non-specific. “Mainstream Doctors and nurses“, can mean anyone or no one. “Often” is a very flexible term. Compared to what? How often is often. “use alternative medicine for themselves“, again no matter how you look at this statement it can’t be wrong or right completely. Alternative medicine is a loose term. Everything is thrown into the bin, vitamins to homeopathy and every mind body woo imaginable. It is useful to have wide error bars when speculating.

After the title, the accuracy declines. “If you go to a mainstream doctor with complaints of tiredness, lack of motivation, general malaise, and insomnia, you’ll likely get an anti-depressant. But, if that same doctor has the same symptoms, he or she may actually seek out other options for their own treatment.” I hope so because that panacea of symptoms requires a complete workup, not anti-depressants. My diagnosis list for starters; hypothyroidism, anemia, coronary artery disease, adrenal insufficiency, heart block, acute renal failure… somewhere down the list depression. Maybe I don’t represent a mainstream health professional? Plug these symptoms into webMD and you get ” viral syndrome, medication reaction, drug side effect, or heat exhaustion. I didn’t find “see your psychiatrist”, or “get your anti-depressants immediately!” in the recommendations. CAM proponents always find it much easier to argue against a straw man than against reality. “An interesting study from Health Services Research shows that most doctors and nurses who operate in mainstream medicine actually have more knowledge and appreciation for alternative medicine than they are letting on.” What qualifies as most doctors and nurses? Knowledge and appreciation for alternative medicine? The survey does not demonstrate any form of motivation. “According to the study, 76 percent of healthcare workers use complementary and alternative medicine (CAM). This is in contrast to the 63 percent of the general population who use CAD. Based on those numbers, your doctor may be more likely to use things like herbs and meditation than you are. Weird.” Weird is not the term I would use to describe that number. Unbelievable would be closer.

I had to do quite a bit of digging to track down the “research” that indicates that 76% of doctors and nurses use CAM on their own. The original study was NIH’s 2007 CAM survey. In the original survey 23,000 respondents were voluntarily surveyed. In study quoted by the author, researchers retrospectively selected 14000 surveys using employed as the criteria. Then they selected 1280 surveys that were employed in ambulatory health centers. Then they split them into their own categories lumping doctors and nurses together in one group of “Providers”. I am uncertain based on the research if employed category included self employed.

Next I will list the researcher’s admitted limitations. “There are several study limitations. First, the healthcare industry and occupation categories in our analyses are broad. We were limited to the industry sub-types identified in the NHIS data. Moreover, NHIS does not release detailed occupation categories and has combined providers in a single group since 2005. Thus, use of gross healthcare occupation categories may mask heterogeneity of CAM use within each category. Second, the NHIS alternative health supplement is a periodic addition to the annual survey. A single year of NHIS data results in small groupspecific sample sizes inhibiting comprehensive group-specific analyses. Third, in the NHIS, CAM use is self-reported, which depends on respondents’ ability to properly identify CAM therapies that have been used; an identification that may be erroneous. For example, the high prevalence of vitamin and mineral use is likely due to the inclusion of daily multivitamin supplementation, not typically considered a CAM therapy. Consequently, we ran our analyses both including and excluding diets, vitamins and minerals, and herbal supplements. While the prevalence estimates changed, the overall conclusions did not. Finally, we categorized therapies as practitioner-based or self-treatment, but some therapies classified as self-administered may have resulted from a CAM practitioner visit.”

I will make my critique as simplistic as possible so not to bore anyone too much. It is an single study. The authors of the “research” took a voluntary CAM survey and cherry picked data. They got a number and have drawn weakly supported claims. The author has extrapolated off of the claims.

To make this study marginally informative for evaluation of health care professionals you would have to have the following. A representative sample, and they didn’t. A survey for healthcare workers. A randomized survey. It was retrospective. It was a selected population from another selected population. The researchers need blinding, they were not. They selected the categories and who was lumped together.

In addition. Their exclusion criteria was employment. Why is that a variable for health care providers? The term “Nurse” Like “Doctor” are broad and lack specificity. A medical doctor is a significant difference from a doctor of chiropractic, or a licensed practical nurse compared to a registered nurse.

As an aside.. Lumping Doctor and Nurses together, in my opinion, is stacking the deck. I am ashamed to say that nursing is filled with medical woo, for a variety of reasons. There are 2.74 million nurses in the US. There are approximately 984000 physicians licensed in the US. It is far easier to find CAM in the nursing department than the medical department. I suspect that they lumped physicians in with nursing because the MD respondents were probably minimal. If they had 90% physicians that would have been the category not health professionals.

That is it. One study. That is the best evidence they have for “Doctors and Nurses Often Use Alternative Medicine for Themselves” . Even if I assume it is representative(it is not), so what? It is sad yes, but not SCIENCE. Argument from popularity. Argument from authority. NOT evidence of effectiveness. It is a sad commentary on those healthcare providers but it is not supportive of CAM. An alternate equally plausible theory, they can’t write prescriptions for themselves. In the US true and not a theory.

Of course all of the suggestive data shenanigans are to prop up the common arguments for CAM supporters. “Why is this? It likely has to do with the fact that medical professionals are on the front line—they see mainstream medicine– including the proliferation of prescription drug usage– up close and personally. They know the shortfalls of focusing on the disease rather than treating the cause and they know they can do better with CAM.” Yes yes… “the old focus on the disease ploy”( Inspector Clouseau, Peter Sellers). Typical CAM assumption. Completely wrong. Nothing makes me happier than curing someone, it is the best feeling in the world. Giving someone a knee replacement and eliminating pain doesn’t put you out business. It gives you a line out the door with people that want the same fix. People are always; aging, living a poor lifestyle, injuring themselves, and acquiring infections. No matter how many you “cure” there will always be more coming. If company X comes up with pill Y, that completely cures osteoarthritis, it does not put them out of business. It turns them into the railroad barons of the 21st century. It would be a license to print money. Focusing on disease and not the cause is a ridiculous and facile argument.

My opinion, CAM advocates lack the tools to properly understand the “cause” of any disease.

The author next argues unsupported extrapolations from the poorly done research. “It is interesting that professionals who are the face of prescription medication are using alternatives. It should speak volumes that they choose to use options other than prescriptions whenever possible.” That is not what the poorly done research data indicates. FYI, doctors are not the face of prescription medications, the TV is.

The author ends with an out and out false statement propping up an unsupported claim from bad research conclusions. “The average American between the ages of 19 and 64 takes nearly 12 prescription drugs each year. And these drugs aren’t making us any healthier. Our life expectancy is declining faster than other industrialized nations and we’re currently ranked 49th in life expectancy worldwide.” Wrong, life expectancy in 1970, male 67.- female 74.7, 2010 male 75.7- female 80.8. Not declining still improving. The reasons the US is behind other western nations is multi-factorial. CAM is not one of the factors. “Healthier” sounds nice but what does that mean. Do people still have incurable chronic problems, yes. Do some prescription drugs improve and prolong quality of life? Unequivocal yes. Are prescription drugs a panacea cure all? Not even close. Are prescription drugs the only way we treat illness? Not even close. Saying there are problems with science based medicine does not say anything about the effectiveness or usefulness of CAM.

“But these statistics begs the question: why do most doctors simply prescribe a drug if they are delving into alternative treatments themselves? Either these stats are inaccurate, and a lesser amount of doctors use alternative medicine, or doctors don’t care to mention their involvement with alternative medicine, and care only about prescribing more pills.” The “question” is answered. The stats are suggestive of poor research methodology, not the author’s conclusions.

The only part of this article I agree with is the last line.”Next time you go in for a doctor’s visit, try asking if he/she uses alternative medicine.”

Please, Please ask.

Complementary….To Quote The Princess Bride “You keep using that word. I do not think it means what you think it means.”

Acupressure, for which there is evidence of limited efficacy, is used by some Doctors … and given that it might work, and it has no down-side at all (pushing on your own wrist to help alleviate nausea is what I’m referencing specifically) it seems reasonable for anyone to try it. I’ve tried it – not sure if it worked or not – but it didn’t seem to hurt anything.

I know one doctor who, if feeling a little down, will have some St John’s Wort Tea, but will do so with the full knowledge that this is self-medication using a real DRUG – one which comes directly from a flower rather than from a drug company chemist, but a drug nonetheless. Again, there are studies showing that this works (not as well as some other drugs, but it works for most people somewhat). Not sure if that’s considered CAM – they know it’s a drug, and that’s why they are using it. The fact that it’s a flower is irrelevant. If a stronger effect were required, they’d take a a different drug, made by a chemist.

These two examples might count as CAM, but are completely different to Reiki or homeopathy or any other garbage. I don’t think you can lump all the CAM together and draw much from ‘the use of CAM’ – it depends what they’re doing specifically..

I hurt my back and was prescribed a painkiller which seemed to be doing nothing. When I looked up the evidence from recent drug trials, I found out more than two thirds of people have NO response to this drug at all, and yet I’d been prescribed it to help with my pain. Needless to say I had a few words with my doctor next time I saw him, and berated him for wasting my time, money, and effectively causing me pain, and then told him to keep up with his reading. Faith in things which are shown to be useless goes both ways unfortunately.

“Needless to say I had a few words with my doctor next time I saw him, and berated him for wasting my time, money, and effectively causing me pain, and then told him to keep up with his reading. Faith in things which are shown to be useless goes both ways unfortunately.”
Absolutely correct, faith is useless, data, evidence, sound methodological research, that is what matters. That is the great thing that science based medicine has, the ability to learn and adapt. CAM does not respond to negative outcomes it refuses to respond to negative research. Science is in motion and allows you to learn and adapt treatment when it succeeds and when it falls short. Alternative medicine does not adapt to negative research and continues to advocate even when the danger has been shown or the effectiveness discounted.

For subjective complaints only no external measure or disease improvement. Medical treatments need to have a better than placebo outcome to be approved.

“A common belief is that the placebo effect is largely a “mind-over-matter effect,” but this is a misconception. There is no compelling evidence that the mind can create healing simply through will or belief. However, mood and belief can have a significant effect on the subjective perception of pain. There is no method to directly measure pain as a phenomenon, and studies of pain are dependent upon the subjective report of subjects. There is therefore a large potential for perception and reporting bias in pain trials. But there are biological mechanisms by which mental processes can affect pain. There are many non-specific factors that can biochemically suppress pain. For example, increased physical activity can release endorphins that naturally inhibit pain. For these reasons the placebo effect for pain is typically high, around 30%.

But the more concrete and physiological the outcome, the smaller the placebo effect. Survival from serious forms of cancer, for example, has no demonstrable placebo effect. There is a “clinical trial effect,” as described above – being a subject in a trial tends to improve care and compliance, but no placebo effect beyond that. There is no compelling evidence that mood or thought alone can help fight off cancer or any similar disease.”

Tell that to a cohort that hasnt got a suggestibility fraction to their disease.

Go on, tell pancreatic cancer sufferers that placebos are useful.

I keep using the masseuse example from time to time. The local masseuses provide a wonderful TOTAL service that is half the price of the local chiropractors, reiki magicians, acu(whatevers) or naturopaths.

Sure you may have qualms about attendance being politically incorrect when applied to womens rights. Thats a good placebo as attendance at the other practioners will surely dumb your kids down when you say..

“Placebo’s are evidence based”.

What the hell is that sort of contribution to the debate? A placebo is designed to do nothing. Its a control. If doing a scientific measurement (rather than an EB style test) one does not use a placebo.

You need controls in experiments and the sooner the mantra “placebo effect” is removed from the lolling and idly ignorant, the closer they are to a scientific literacy.

Only a cam operator uses the term and only a cam operator would blithely ignore the astounding amount of SBM carried out on “natural” compounds.

EB by the illiterate (my bug bear of the feckless publish or perish set) is only EB by the illiterate. You should read their articles bearing that in mind.